Succeeding in Rural Mental Health Practice: Being Sensitive to Culture by Fitting in and Collaborating

Sustainable solutions to the access to mental health care problems are complex and must address both the availability of mental health care resources and the acceptability of those resources to consumers. The purpose of this study was to determine how to address the acceptability problem by learning from medical and mental health care providers what mental health therapists need to know to be successful in providing care in rural communities. Using a qualitative design, focus groups were conducted in three rural communities (<2,500) with medical and mental health care providers practicing in these communities. Data were analyzed using inductive qualitative methods. Results indicate that in addition to sound clinical skill, mental health therapists should (A) be sensitive to the culture of the rural community in which they are working and (B) practice in a way that accommodates to the care culture of the community. The latter includes spending time with patients commensurate with what is expected by other providers, engaging in generalist practice, and collaborating with local providers in patient care. An important implication of these results is that mental health care must be acceptable to both the residents of the community and the gatekeepers to health care.     

Different sides of the same conversation: Black and White partners differ in perceptions of interaction content

A positive interracial interaction can create a foundation for friendships, improved intergroup attitudes and reduced prejudice. Recent research has demonstrated that what people talk about in important. Here, two studies expand the interaction content model of interracial interactions to reveal that Black and White Americans perceive interaction content in similar and different ways. As expected, Black and White participants evaluated conversation topics along the same three dimensions, but differed in their perceptions of specific conversation topics. These convergences and differences emerged for pre‐generated (Study 1) and self‐generated (Study 2) topics. Factor analyses revealed that conversation attributes similarly distilled to the predicted underlying content dimensions of intimacy, valence, and controversy for Black and White Americans. However, Black individuals found interaction content, in general, to be more controversial, race‐related, enjoyable, and predictable than White individuals. Although both groups found race‐related content more controversial, Black individuals were less bothered by discussing race and found race‐related topics to be more predictable and enjoyable to discuss. These findings supported the interaction content model which may provide a framework for future research on interracial interactions. We conclude with the importance of considering differences in perceptions of interaction content, as well as suggestions for how intergroup interaction research could benefit from systematically incorporating such content.     

An Auto‐Ethnographic Study of “Open Dialogue”: The Illumination of Snow

This auto‐ethnographic study describes the changes in the author's thinking and clinical work connected to her first‐hand experience of Open Dialogue, which is an innovative, psychosocial approach to severe psychiatric crises developed in Tornio, Finland. In charting this trajectory, there is an emphasis on three interrelated themes: the micropolitics of U.S. managed mental health care; the practice of “dialogicality” in Open Dialogue; and the historical, cultural, and scientific shifts that are encouraging the adaptation of Open Dialogue in the United States. The work of Gregory Bateson provides a conceptual framework that makes sense of the author's experience and the larger trends. The study portrays and underscores how family and network practices are essential to responding to psychiatric crises and should not be abandoned in favor of a reductionist, biomedical model.     

Reducing automatically activated racial prejudice through implicit evaluative conditioning

The authors report a set of experiments that use an implicit evaluative conditioning procedure to reduce automatically activated racial prejudice in White participants in a short period and with relatively few trials. Experiment 1 demonstrated that participants were unaware of the repeated conditioned stimulus-unconditioned stimulus (CS-US) pairings of Black-good and White-bad. In Experiment 2, the procedure was found to be effective in reducing prejudice as indicated by an evaluative priming measure of automatically activated racial attitudes. In Experiment 3, this reduction in prejudice was found to persist throughout a 2-day separation between the conditioning procedure and the administration of the dependent measure. The implications of the present findings for the persistence of automatically activated racial prejudice are discussed.     

Processing Speed Deficits in Attention Deficit/Hyperactivity Disorder and Reading Disability

The goal of the current study was to test whether deficits in processing speed (PS) may be a shared cognitive risk factor in reading disability (RD) and Attention Deficit/Hyperactivity Disorder (ADHD), which are known to be comorbid. Literature on ADHD and RD suggests that deficits on tasks with a speeded component are seen in both of these disorders individually. The current study examined a wide range of speeded tasks in RD, ADHD, comorbid RD+ADHD, and a control group to test whether RD and ADHD have similar profiles of PS deficits, and whether these deficits are shared by the two disorders. The results suggest that a general PS deficit exists in both clinical groups compared to controls, although children with RD demonstrate greater PS deficits than children with ADHD. Two tests (underadditivity and partial correlations) were conducted to test whether these PS deficits are shared. Since we found that PS deficits were underadditive in the comorbid group and that partialling PS reduced the correlation between RD and ADHD, it appears that PS is a shared cognitive risk factor that may help explain the comorbidity of these two disorders.     

Internalizing Trajectories in Young Boys and Girls: The Whole is Not a Simple Sum of its Parts

There is support for a differentiated model of early internalizing emotions and behaviors, yet researchers have not examined the course of multiple components of an internalizing domain across early childhood. In this paper we present growth models for the Internalizing domain of the Infant-Toddler Social and Emotional Assessment and its component scales (General Anxiety, Separation Distress, Depression/Withdrawal, and Inhibition to Novelty) in a sample of 510 one- to three-year-old children. For all children, Internalizing domain scores decreased over the study, although girls had significantly higher initial levels and boys had steeper declines. General Anxiety increased over the study period and, when modeled individually, girls evidenced higher initial levels and greater increases. For all children, Separation Distress and Inhibition to Novelty decreased significantly over time, while Depression/Withdrawal remained low without change. Findings from our parallel process model, in which all components were modeled simultaneously, revealed that initial levels of internalizing scales were closely associated while rates of change were less closely related. Sex differences in variability around initial levels and rates of change emerged on some scales. Findings suggest that, for one- to three-year-olds, examining scales of the internalizing domain separately rather than as a unitary construct reveals more meaningful developmental and gender variation.